April 1 marks start of Japan’s new medical fees and processes

Last week, after more than a year of intense deliberations among various stakeholders, a panel under the Health, Labor and Welfare Ministry released a long list of changes to the nation’s medical fees.

The fee review, which takes place every two years, has been a major policy tool for the government and shows the direction of the nation’s health care as the population grays and medical needs surge and diversify.

Under the national public health insurance scheme, the government controls the prices of all procedures performed and medications prescribed by hospitals and clinics. By tweaking fees here and there — and thereby offering or robbing financial incentives for specific procedures — the government wants to keep the nation’s health care costs from shooting through the roof while meeting new needs to provide quality services in high-priority areas such as cancer and dementia.

Patients, though they have little direct say in this policymaking process, are inevitably affected. Every resident of Japan is required to join the public health insurance program and pay monthly premiums; in exchange, they are entitled to receive care by shouldering up to 30 percent of the cost at the hospitals and clinics they visit.

Here are some of the highlights of this year’s fee review, which will take effect nationwide on April 1.

Community-based care and family doctors

Japan has a “free access” system, meaning patients can seek care at any clinic or hospital across the nation. But the system has long been criticized for encouraging patients with symptoms as light as a common cold to flood large hospitals that boast cutting-edge facilities, leaving them overcrowded and unable to offer proper care to patients with more serious conditions. While the number of “family doctors” is small, the government wants to push more patients to make a habit of first going to their community physicians, where they will be referred to large hospitals only when necessary.

Currently, if nonemergency patients go to hospitals without referrals, they are slapped with a surcharge of at least ¥5,000. With the revision this time, all hospitals with 400 beds or more will start charging such a fee, as opposed to those with 500 beds or more currently.

In addition, community doctors who see patients with chronic illnesses, such as high blood pressure, diabetes and dementia, will be allowed to charge ¥800 per patient for their first visit on condition that the doctors will monitor their condition over the long term.

Telemedicine

The ministry panel for the first time will introduce several new fees for doctors offering counseling over the internet, as needs for telemedicine have increased.

For example, doctors offering care to people with certain chronic conditions, such as dementia and diabetics who have yet to move to the dialysis phase, are eligible to charge a monthly fee of ¥700. But there are various restrictions attached. Doctors need to spend at least six months offering face-to-face sessions before switching to online counseling and they need to mix online sessions with in-person ones.

Expenses will likely go down for some patients. According to the panel’s simulation, a 45-year-old man with hypertension who gets prescribed medications once a month will pay about ¥3,000 per two months if he switches to telemedicine, compared with about ¥5,000 for the same period when he chooses to see the doctor at the clinic every month.

Generic drugs

To further promote the use of generic drugs, the government will reward large pharmacies that distribute such medicine, by creating a fee they can claim for filling 85 percent or more of their prescriptions with generics. Meanwhile, pharmacies with a generic drug distribution ratio of 20 percent or less will have their compensation slashed by ¥20 per prescription.

Gender reassignment surgery

From April, people with gender identity issues will be eligible to have gender reassignment surgery at accredited institutions covered by public insurance. Surgeries covered include removal of the testicles, penis or uterus, as well as mastectomies.

People in Japan with gender identity issues must undergo sex reassignment surgery to have their registered gender changed on public records. Some people desiring the surgery have gone abroad, finding that the cost in Japan was too high.

According to a survey by the Japanese Society of Psychiatry and Neurology, the number of people diagnosed with gender identity disorder who have had treatment at medical institutions in the country totaled 22,435 by the end of 2015.

Cancer treatment and care

Robot-assisted endoscopic surgeries for various cancers will be included in public insurance coverage. Such surgeries include removal of tumors in the stomach, lungs, esophagus, rectum and uterus.

Also, radiation therapy for prostate cancer using heavy ion beams and proton beams will be covered.

Doctors and nurses offering support for cancer patients so they can keep working will be rewarded with new fees. Such professionals will liaise with patients’ company doctors to come up with the best care plan and offer advice to their employers.